Agreement Between Integrated Management of Childhood Illness and Final Diagnosis in Acute Respiratory Tract Infections
To evaluate the agreement between integrated management of childhood illness (IMCI) and final diagnosis in patients presenting with cough at the second and third level health institutions.
This cross-sectional study included 373 children aged 2–60 mo who presented with cough at the pediatric emergency and outpatient clinics in the Department of Pediatrics. After clinical examination of children, body temperature, respiratory rate, saturation, presence or absence of the chest indrawing, rales, wheezing and laryngeal stridor were recorded. Cases were categorized according to IMCI algorithm regarding the severity using the color code, such as red (urgent treatment), yellow (treatment in the hospital), or green (treatment at home). Final diagnosis after physical examination, laboratory analysis and chest X-ray was compared with the IMCI algorithm.
Study agreement between IMCI classification and final diagnosis was 74.3% with kappa value 0.55 (moderate agreement). Similar agreement values were detected in both the second and third level health institutions. Health condition and gender did not affect agreement value. Agreement were found to be high in patients <24 mo of age (ĸ = 0.67), presence of fever and cough (ĸ = 0.54), tachypnea (ĸ = 0.93), chest indrawing (ĸ = 1.00) and oxygen saturation of <94%(ĸ = 0.90).
Adding saturation level to the IMCI algorithmic diagnosis may increase agreement between IMCI classification and final diagnosis.
KeywordsIntegrated management of childhood illness Saturation Children Tachypnea Pneumonia
SSY: Composed the theme of the manuscript; BÖ and SÖ: Collected the data of the patients and wrote the manuscript; EB: Collected the data of the patients. Dr. Kadriye Yurdakok, Department of Pediatrics, Unit of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
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